Azathioprine Bioequivalence study in Rheumatoid Arthritis

Completed

Conditions: Rheumatoid Arthritis

Registration Number: CTRI/2010/091/000070

Lead Sponsor: Orion Pharma

Brief Summary: This study is an open label, balanced, randomized, multiple-dose two-period, two-treatment, two-sequence, steady state, crossover comparative bioequivalence study of two formulations of Azathioprine in adult patients with Rheumatoid Arthritis (RA). To assess and compare the steady-state pharmacokinetics of an oral formulations of Azathioprine (test product) in comparison with oral formulations of Azathioprine (reference product) in adult patients with Rheumatoid Arthritis (RA). To assess the safety of Azathioprine in the adult patients with Rheumatoid Arthritis (RA). Total 42 patients will be enrolled in the study.

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: All

Target Recruitment: 42

Inclusion Criteria

Inclusion Criteria: 1.Adult patients, either sex, aged between 18 and 55 years (both inclusive) with acceptable BMI.
2.RA patients on maintenance therapy with twice daily 50 mg oral Azathioprine with or without a fixed dose (maximum of 30 mg/week) of Methotrexate.
OR Having moderate to aggressive disease stage, as per American Rheumatism Association defined by the presence of at least 3 of the following criteria: (a) tenderness of more than 6 joints (b) swelling of more than 3 joints (c) morning stiffness longer than 45 minutes (d) articular index greater than 20 (e) ESR greater than 28 mm/h.
3.CRP, ANTI-CCP antibodies & RA factor done within 6 months of screening or at screening suggestive of active Rheumatoid arthritis.
4.Subjects must be off corticosteroids or on a stable dose of corticosteroid for at least 2 weeks prior to enrollment.
The maximal daily dose of corticosteroid at Baseline must not exceed the equivalent of 10 mg of prednisone.
5.Subjects must be free of any clinically significant condition or situation, other than RA that, in the opinion of the investigator, would interfere with the study evaluations or optimal participation in the study.
6.Liver and kidney function (ALT /AST/ AP / creatinine < 2 x upper normal limit).
7.Subject Screening and Baseline clinical laboratory tests (complete blood count [CBC] and blood chemistries) must be within acceptable ranges.
8.Subjects are willing and able to adhere to the study visit schedule and other protocol requirements as evidenced by a written informed consent.
9.Women of child-bearing potential and all men must agree to use a medically accepted method of contraception prior to screening, while receiving protocol-specified medication, and for 6 months after stopping the medication.
Acceptable methods of contraception include condoms (male or female) with or without a spermicidal agent, diaphragm or cervical cap with spermicide, medically prescribed intrauterine device (IUD), oral or injectable hormonal contraceptive, and surgical sterilization (e.g., hysterectomy or tubal ligation).

Exclusion Criteria

1.Adult patients with RA on therapy with any other agent apart from twice daily dose of Azathioprine alone or along with use of NSAIDs, fixed low-dose glucocorticoids and/or fixed dose of Methotrexate.2.Anemia (hemoglobin < 08 gm %).3.Patients with low or absent TPMT activity who are at increased risk.(<5.5 unit).4.Bone marrow suppression (platelets / leucocytes < 1 x lower normal level).
5.Small bowel surgery interfering significantly with resorptive area.
6.Concomitant use of allopurinol, ACE-inhibitors or furosemide.
7.Pregnancy, expected pregnancy or lactation within 6 months.
8.Subjects who have a history of a known allergy/sensitivity to study drug or its excipients.9.Subjects who have had serious infections (eg, active hepatitis, pneumonia, or pyelonephritis) within 2 months of screening.
Less serious infections (such as acute upper respiratory tract infection [colds] or a simple urinary tract infection) need not be considered as exclusion at the discretion of the investigator.10.Subjects who have had a nontuberculous mycobacterial infection or opportunistic infection (eg, cytomegalovirus, Pneumocystis carinii, aspergillosis) within 6 months prior to Screening.11.Subjects who have a known infection with human immunodeficiency virus (HIV) and/or hepatitis B or hepatitis C.
12.Subjects who have current signs and symptoms of systemic lupus erythematosus, or severe, progressive, or uncontrolled renal, hepatic, hematologic, endocrine, pulmonary, cardiac, neurologic, or cerebral diseases.
13.Subjects who have a known history of demyelinating disease suggestive of multiple sclerosis or optic neuritis.
14.Presence of a transplanted organ (with the exception of a corneal transplant >3 months prior to screening).15.Subjects who have a history of lymphoproliferative disease including lymphoma, or signs and symptoms suggestive of possible lymphoproliferative disease, such as lymphadenopathy of unusual size or location (eg, nodes in the posterior triangle of the neck, infra-clavicular, epitrochlear, or periaortic areas), or splenomegaly.
16.Subjects who have any current known malignancy or malignancy within 5 years prior to screening (except for squamous or basal cell carcinoma of the skin that has been treated with no evidence of recurrence).
17.Subjects who have poor tolerability of venipuncture or lack of adequate venous access for required blood sampling during the study period.
18.Subjects who have had a known substance abuse or dependency (drug or alcohol) within 3 years of Screening.19.Subjects who have other inflammatory diseases that might interfere with the evaluation of the Rheumatoid Arthritis.20.Subjects who have a history of latent or active granulomatous infection, including TB, histoplasmosis, or coccidioidomycosis, prior to Screening.
21.Subjects who have received any specified prohibited treatment more recently than the indicated washout period prior to Screening.
22.Subjects who are participating in any other clinical study or who have received treatment with any investigational drug or device within 3 months prior Screening.23.Subject who is part of the staff or a family member of the staff personnel directly involved with this study.
24.Any other condition that, in the investigator?s judgment, might increase the risk to the patient or decrease the chance of obtaining satisfactory information needed to achieve the objectives of the study.25.Abnormal baseline findings considered by the investigator to indicate conditions that might affect study endpoints.
Note: If the patient has participated in a study in which blood loss is ≥ 200 mL, patient can be dosed only after completion of 60 days from the previous study.

Study & Design

Study Type: BA/BE

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Bioequivalence will be established if the estimated 90% confidence intervals of the ratio (test/reference) of AUCtau and Cmaxss will be within the acceptance range. The acceptance range for bioequivalence is 80-125%, unless the intra-subject CV turns out to be more than 30% (i.e., Azathioprine and 6 Mercaptopurine highly variable) then the acceptance range for Cmaxss is 75-133%.	pre-dose, 10 min, 20 min, 30 min, 40 min, 50 min, 1 hr, 1 hr 15 min, 1 hr 30 min, 1 hr 45 min, 2 hr, 3 hr, 5 hr, 8 hr and 12 hr

Secondary Outcome Measures

Name	Time	Method
To assess the safety of Azathioprine in the adult patients with Rheumatoid Arthritis (RA)	Safety parameters like Physical examination, ECG (screening and post study) adverse events, vital signs, will be recorded in the study

Trial Locations

Locations (2): Center For Rheumatic Diseases (CRD)
🇮🇳
Pune, MAHARASHTRA, India
Centre for Knee and Hip Surgery
🇮🇳
Vadodara, GUJARAT, India
Center For Rheumatic Diseases (CRD)
🇮🇳Pune, MAHARASHTRA, India
Dr Arvind Chopra
Principal investigator
02026345624
crdp@vsnl.net